Bainbridge Island Recreation Center: Couple Resident

Primary Member Information

First Name

M.I.

Last Name

Address 1

Address 2

City

State / Province

Zip / Postal Code

Home Phone

Mobile Phone

OK to Contact Home Phone

OK to Contact Mobile Phone

Preferred Phone

Home

Mobile

OK to Contact Email?

Birth Date

Monthly Payment

$165.83

$130.92

Service	Down Payment	Recurring	Rollover	Visits
Member 1
Basic Class	$0.00	$0.00	$0.00	0
Couples Monthly Dues	$0.00	$152.00	$0.00	0
Prorated Dues	$120.00			0
Sub-Total	$120.00	$152.00
Tax	$10.92	$13.83
Total	$130.92	$165.83

Payments will then be processed on a Monthly basis there after.

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